We live in a society historically designed for people with full mobility, good hearing and eyesight, and good cognitive processes. In the past, people who did not fit this profile were expected to either unobtrusively adapt, stay out of view, or live within an institution. Disabilities meant that people were considered "less than." Not a lot of societal thought considered the extent to which these discriminatory attitudes and practice were integral to the design of our world - and the extent to which people were actually disabled by their environments.

When interacting with someone who has a disability, it can be more important to focus upon their abilities, their personality, and the experiences shared with you.

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In response to societal discrimination, the original Americans with Disabilities Act (ADA) enacted in 1990, was based upon the concept that many "disabilities" are the result of dissonance between a human body and its environment. There are solutions for that dissonance.

When those using walkers, wheelchairs, and other mobility devices can readily enter, traverse, and exit a building or transit system, then their "disabilities" do not prevent them from fully participating in society. When signs are in Braille, elevators have audible cues, and there is nothing encroaching into hallways, aisles, and walkways, then blindness is not a "disability." When closed captioning or an ASL translator is available, then deafness is not a "disability"

It has been quite a journey for ADA implementation over the last 25 years.

Seeing people as people changes attitudes and makes many issues evaporate.

It is equally true that many developers, business owners and others impacted by ADA requirements resented providing more universal designs or expanded accessibility then, and often still do now. "Government Overreach" is a common refrain of frustration and outrage at what is perceived as interference with property rights - if owners of public spaces choose not to cater to what they view as a small minority, then that exercise of property rights should not be considered discrimination...so they say.

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Or, the perceived problem could be that accessible modifications are downright ugly and diminish the marketability of a commercial space or a home. Indeed, there has been no shortage of ugly and/or poorly executed modifications looking like some sort of mis-matched afterthoughts - shown by the two examples below.​However, in today's world, fully one-third of American households have one or more members with some type of disability. Americans are surviving more types of birth complications and are living longer overall. As we do, we are more likely to have physical and/or mental disabilities from birth or disease or to develop disabilities from accidents, war, or age. People who were once "them" in the shadows (and easy to discriminate against) have now become "us" in the foreground.

Accessible adaptations are now commonplace, and many of us, as well as people we know and love, depend upon these adaptations to safely navigate the public world and the private ones. Yet, often ideas about creating accessible spaces are shaped by the myriad bad examples seen across the country. Indeed, it is hard to argue that spending a lot of money to create something unattractive and marginally functional is even a remotely good idea.

ADA Standards - Public Spaces vs. ​Private Homes

ADA standards are intended to eliminate barriers for the greatest number of people using public spaces. These do not apply to private residences.

The Fair Housing Act and the Architectural Barriers Act are also intended to remove physical barriers and end discrimination against people with disabilities. In terms of housing, these acts apply to publicly-funded units or those in a multiple unit rental dwelling or those with publicly subsidized rents.

While accessible adaptations are a good thing overall, it is important to recognize the sharp distinctions between ADA standards, designed to provide some assistance to the greatest number of people (which is surely a good thing), and personalized accessibility strategies designed to offer specific residential support to specific individuals.

ADA Standards for Public Restroom ToiletsThese do not apply to private homes - and often could create problems if used there

Accessible modifications to private homes are not required to conform to ADA standards - and applying ADA standards often creates new and different problems, not solving much of anything.

Home modification strategies should be developed to suit the needs of individuals, their caregivers, and their families. For private homes, using Aging in Place or Universal Design concepts is a far better starting point than ADA standards.

And now... some practical examples

​Grab Bars

We've all seen grab bars. Grab bars come in a wide variety of shapes, sizes, grip surfaces, action, colors, and styles. Yet, many people think of them only as either straight tubes of aluminum or stainless steel. When chosen for function and positioned in concert with the way someone actually uses a bathroom, and bedroom, hallway, kitchen, or entry, and installed securely, grab bars promote greater safety and independence.

And the opposite is too often true. Using the a-grab-bar-is-a-grab-bar-is-a-grab-bar theory and the one-size-fits-all approach, poorly chosen, ill-placed, and badly installed grab bars can decrease safety and reduce independence.

Grab Bars come in many shapes, actions, and styles so they can be mixed and matched to find just the right ones for individual situations.

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Let's think about this. At 85, Mom is all of 4 feet 10 inches tall. She has arthritis in most of her joints, and she is not as strong as she once was, nor is her balance always the best. So, you are looking at grab bars for the bathroom to help her use the shower and toilet.

If you just look at ADA standards, which some public funders of residential modifications have resorted to, then she would have a 36 inch long bar mounted behind the toilet, between 33 and 36 inches from the floor, and a 42 inch long bar mounted beside the toilet, again between 33 and 36 inches from the floor and 12 inches out from the corner of the back and side walls. The height of this arrangement would mean that tiny Mom is now forced to use body mechanics better suited to climbing a jungle gym than using her toilet. Plus, there is no room behind the toilet for a 36 inch long bar, much less a 42 inch long bar alongside.

Signature Series

Instead, she would benefit from something like a 45 degree angle bar with vinyl grips mounted on the wall beside the toilet. And both she and her caregiver would benefit from a swing-up bar on the open side of the toilet (pictured left). She can barely reach the wall behind, so a bar there would be useless to her, although perhaps of use to her caregiver. The right bars in the right spots will help both of them.

And do not skimp on mounting. Grab bars must be secured to wall studs or to blocking between the studs, or to UL approved grab bar wall anchors, otherwise they are likely to come loose with time and use.

Another cautionary grab bar tail relates to suction cup versions. How many times have we heard someone's initial delight in finding a cheap grab bar alternative turn to dismay a few months later when it unexpectedly comes loose because the cup material was failing or because the cup inadvertently covered a grout joint and lost suction? These products may seem like a good idea - right up until the moment when someone has a surprise fall. In that instant, they are revealed as a bad idea. Below are some examples of quality grab bars that allow for safety and design when installed correctly and at the correct height.

HealthCraft

Great Grabz

Walk-In Tubs

Don't those ads look great?! Not having to step over the 17 inch side of a bathtub certainly seems a fabulous idea for those with mobility issues. Enjoy a relaxing bath - without the challenges and risks of getting in and out of the tub. And a higher end model with hydro-jets massaging your aching muscles and joints... oh, my! The whole experience sounds like bliss.

Snowman? Wait, what is that snowman doing over there? Well, what if someone asked how much you would enjoy shivering in a tub while it slowly filled and then again when it slowly drained? You wouldn't? Well, you are not alone; not many people do.

You always have the option of paying extra for fast-filling faucets and larger drains that can reduce, but no eliminate, discomfort. However, be realistic before spending the money. The diameter of your home's plumbing and any hidden clogs will determine how fast you tub can fill and drain. Heated seats and heat lamps are other upgrade features that can reduce discomfort.

Keep in mind another aspect of draining time. In case of an emergency (minor or major), you are not just going to open the door and get out. You will be sitting there waiting for several minutes until the tub drains before the door opens.

First, what size is your water heater? Walk-in tubs, usually hold more water volume than the standard bathtubs they replace. Even with temperature setting turned up all the way, not all water heaters are able to provide enough hot water to make even a 10 minute bath warm, much less manage that for 20 or 30 soak you long for.

Second, what does the seat look like? Most models are design for the occupant to sit upright, not for the reclining soak position many people expect. That mean your top half may be above the waterline. And while searching for the right seat, be sure to look for one that tilts backwards just enough so that you are not likely to inadvertently slip off. Speaking of physical dexterity, most models also have in-swinging doors, so the bather must have the mobility to get out of the way of the door before being seated in the tub. As time goes on, many of us will need some help getting in and out as well as while bathing. Most tubs are designed for the bather alone, making it difficult for a caregiver to give assistance.

A walk-in tub might be suited for you, but pause and think of everything before investing a hefty sum in one of these tubs. Look carefully at the warranty and check the manufacturer's background. What is its track record resolving problems with leaking seal and other defects?

Water leaking onto the bathroom floor can create the very fall risks you were trying to avoid as well as damage your flooring. A leaking seal is the number one problem with these tubs, and not every company provides top notch customer service. You want one that delivers a high quality product and provides great service when there is a problem.

If you fully understand the pros and cons before paying thousands for a walk-in tub, and you have actually compared several models, you are more likely to find what you need and less likely to be unpleasantly surprised later.

Now..if you're rethinking this, are there any alternative solutions to explore?

Yes, there are three man directions to go.

Drive Medical

First, and the least involved option, is a battery-powered bath lift - a seat which raises and lowers you in and out of the bathtub. They use large suction cup feet to attach to the tub, have waterproof controls, and some models come with seat backs that tilt at multiple angles.

However, you will need access the seat and move your legs over the edge of the tub. Something like a Beasy Transfer Board can simplify that process.

Also think about the height of your tub because a lift take up tub space. Low tub sides may not be the best combination with a bath lift. Models that take the seat down to about 2.5 inches from the tub bottom provide the greatest immersion.

Best Bath Systems

Second, if you really want a bathtub, then consider transfer-style tubs. Some have out-swing doors (like a car door) that fully expose the seat so you can directly transfer from a chair or scooter. Others have sliding doors that also open to expose the seat for ready transfer. However, they still require a person to wait while the tub fills and drains, so some heat lamps above are a good idea.

Best Bath Systems

​Third, a barrier-free shower may be what will make the most sense in the long-term. Some showers have nearly no threshold while others have anything from an inch to several inches. The higher the threshold, the great the chance of keeping water inside the shower unit, but that threshold step also represents a real barrier to safe, independent use.

Keeping water inside the shower can be an on-going battle with a very low threshold. Fortunately, there are linear drains for the front edge, flexible water dams, very heavy-duty weighted curtains, and assorted clips that hold the curtain against the wall.

Integrity Custom Concepts

A barrier-free shower allows someone to walk in or roll in. Finding the right chair suited to specific needs (or having it) made with the right straps, bolsters, seat, movable arms, etc.) can greatly simplify shower use for both bather and caregiver and greatly improve overall hygiene.

Whether or not you decide a walk-in tub is right for you, any bathroom modification (accessible or not) is normally expensive. It is also true that while gutting an existing bathroom and making it completely accessible may cost $16,000 to $20,00, balanced against the expense of facility care, this can be highly cost-effective - but if, and only if, the modifications are specifically tailored to address hygiene needs and safety factors.

To be sure you will have what you need at a price you can afford, when making you bathing decision, consider several factors first:

Define what your bathing needs are and what you will likely need in 3 years, 5 years, and 10 years - for independence and for a caregiver.

Determine how the new bathroom modifications will be kept clean and in good repair.

Understand exactly how each option will impact your budget.

Many modifications appear to be very pricey but when compared to hospital stay bills or facility living even for a short period of time can actually save you money overall.

​Ramps

Ramps are everywhere. So ordinary that we think we know what a ramp is, what it does, how it is used. This is hardly rocket science, as they say.

Well, that may be. Yet ramps remain one of the most frequently screwed up accessible modifications there are. Pictures of the strangest examples abound on the internet.

A few basic questions begin the process:

What sort of mobility device - manual chair, power chair or scooter, walker or crutches or cane?

Independent use or with assistance?

What type of assistance?

What sort of entry

Able to use a door handle?

Hasselfree Clipart

What difference does it make?

A manual chair self-propelled by someone with good upper body strength is a different scenario than a 200 pound man in a manual chair pushed with assistance from his 80 year old wife who deals with her own health problems.

Typical 1:12 slope may be fine for the person self-propelling, but if you were the 80 year old wife, you may find that too steep to push you husband up or down. A 1:20 or 1:24 slope might be needed to keep you both safe.

Often, a power chair can safely climb or descend a steeper ramp than can a manual chair or walker. A 1:10 slope at home may be fine.

Level Platforms. Typically five feet square at an exterior doorway, where space can be at a premium, people may balk at the idea of using up valuable ramp space for a platform. So they will run the ramp right up to the door threshold. If the in-swinging door will always be open at the right time, then this might work. But if there is a storm/screen door or if the in-swing door must be opened, then that platform becomes very important.

Why? Imagine yourself in a chair rolling up the front door. On a slope about three feet wide, you are now about to perform something akin to a do-si-do maneuver to get into the house:

Keep the chair in place with one hand while you extend the other hand to open the storm door.

As the door opens, you must now back out of that way of the door, opening it past you.

Now, move forward again (remember, you are on a slope going uphill), keeping the storm door beside you, stop, and extend one hand to open the front door.

​Push the front door ahead of you and roll up through the doorway, over the threshold, closing both doors behind you.

When a caregiver needs to all this, he or she must have space for both the other person in the chair and him/herself. You can imagine that doing all this on a 36 inch wide uphill slope presents a number of risks.

A level platform gives the space to perform all these actions without the threat of rolling backwards, falling, and other accidents.

Next Question: Is a ramp really what's needed?

Looking at the example below (left), we see a series of steps that would be impossible for anyone with serious mobility issues to negotiate. On the right, we see the ramp that was installed with about 10 switchbacks. Its gets the job done, but when considering the appeal to local skateboarders, or keeping snow and ice off this much ramp, there are some drawbacks. And cost is another factor - this much ramp is quite expensive.

ykef.co.uk

While there is no simple answer, to a situation like this, there is perhaps a better answer with a vertical platform lift and bridge.

AAS

Mobility Home Services

People using a walker or cane may not want a ramp at all. ​

They may benefit from low rise/deep tread steps no more than half the height of standard steps and twice as deep.

Imagine yourself using a walker in bad weather, going down a ramp. The slope alone tilts you forward. If you lose your footing due to ramp conditions or balance issues, then you will pitch forward.

With these steps, you will need to be able to raise each foot about three inches, but the surfaces you stand on are always level.

​Threshold Ramps

Threshold ramps offer another great opportunity to make fairly large errors.

Entry doors frequently have a threshold kickboard that creates a short step. Getting up or down with a chair can be difficult, if not dangerous. A properly sized and placed threshold ramp can solve the problem. The wrong one can cause problems, and the wrong one is typically too steep, creating a small ski jump - ripe for fall potential (pictured left). The right one should have a slope about 1 inch of rise for 12 inches of length and provide traction when wet.

SafePath

This threshold ramp is a good example:

it has a gradual slope

its sturdy and durable

it fits the step and the porch floor

is flush with the door threshold

is wide enough

offers traction

The Bottom Line

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Whether accessible or not, most home modifications require a significant investment of research, planning, and money to insure they are the best alternatives possible and they are done properly.

Accessible modifications normally require materials and/or skills that come at a higher cost than do typical modifications. Those prices alone are hefty. For example, the cost of an ordinary full bathroom renovation is about $10,000 in most areas of the country, closer to $15,000 in many cities, and even closer to $20,000 in major cities.

Talk about sticker shock! These prices are so stunning to many people considering having work done, they regroup or abandon the idea completely.

And then, when faced with another 10-25% on top of that for accessible modifications, it is immediately clear why good planning to meet individual needs is absolutely imperative. A lot of money and time can be wasted due to inadequate planning and poor execution. When the resulting bad job then creates new problems, rather than eliminate them, the financial, emotional, and functional impacts can be overwhelming.

The goal of accessible home modifications is to eliminate or at least significantly reduce as many barriers and safety risks as possible, allowing people to comfortably live in their homes for years. The cost of a complete accessible bathroom renovation is still less than the cost of a single year in a facility, so it can be a very smart investment. Low interest loans can ease the sticker shock.

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So let common sense rule your accessibility project:

Get professional assistance to help determine what the overall needs are to compensate for disabilities, to address caregiver needs, and to incorporate family concerns​

Develop an accessible modification concept and put some realistic numbers to it.

Determine how the budget meshes with funding available - adjust as necessary.